In the 1990s, heart failure (HF) emerged as a significant public health threat and reached epidemic proportions. As the population of patients with HF increases, millions of family members will become informal caregivers for these patients and provide a central source of support in patients' self-care. Researchers have suggested that support from family or significant others can have a positive impact on patients' outcomes including quality of life, morbidity, and mortality. However, family members can suffer significant stress related to their caregiving and support roles. As a consequence, family members often experience emotional distress (i.e. depression and anxiety). In the inevitable interactions between patients and family caregivers in the HF self-care process, a family caregiver's emotional distress and perceived burden may be transmitted to the patient. It has been reported that HF patients and family caregivers have similar levels of emotional distress. However, it is not known whether family caregiver distress and perceptions of burden. Contribute to patients' poor emotional well-being, quality of life, morbidity, and mortality. In the very limited cross-sectional studies in this area, family caregiver emotional distress was associated with patient quality of life. However, the longitudinal effects of family caregivers' perceived burden and emotional distress on patients' clinical mortality and morbidity outcomes are unknown. The purpose of this longitudinal study is to examine the impact of family caregivers' psychological distress on quality of life and physical health outcomes of adults with HF. A total of 180 HF patient-family dyads will complete questionnaires about emotional distress, caregiver burden, and quality of life. Patients will be followed for one year to collect rehospitalization and mortality data. The candidate has an interest in (1) understanding the relationship between family caregiver, patient psychological factors (i.e. depression and anxiety) and HF patient outcomes; (2) and developing family-based interventions to improve outcomes in patients with chronic cardiovascular illnesses. This grant will allow the candidate to obtain advanced knowledge about patient-family dynamics and psychological distress and receive the training necessary for the longitudinal clinical outcome study and the training to develop family intervention programs. [unreadable] [unreadable] [unreadable]